treatment modalities for genital warts

Imiquimod 5% cream (Grade A). Imiquimod (imidazoquinolinamine) 5% cream is a patient-applied topical immunomodulatory agent, which first received its indication for the treatment of external CA in 1997. It has since been used in the treatment of a variety of skin conditions, including basal cell carcinomas and actinic keratoses. Although its precise mechanism of action remains unclear, imiquimod is believed to activate immune cells by binding to the membranous toll-like receptor. This leads to the secretion of multiple cytokines, such as interferon-α, interleukin-6, and tumor necrosis factor-α, which are critical in the induction of an inflammatory response promoting wart clearance. In addition, imiquimod-treated patients have been shown to have a decrease in viral load measured by HPV DNA, a decrease in messenger ribonucleic acid (mRNA) expression for markers of keratinocyte proliferation, and an increase in mRNA expression for markers of tumor suppression.
For the treatment of CA, imiquimod is applied at bedtime three times per week for up to 16 weeks. Commonly encountered local inflammatory side effects, such as itching, erythema, burning, irritation, tenderness, ulceration, and pain, have been long-standing issues with the 5% cream. Occasionally, patients may experience systemic side effects of headaches, muscle aches, fatigue, and general malaise.
In the pivotal clinical study, wart clearance was achieved in 56 percent of patients. More women (77%) than men (40%) cleared their warts, with the male study population comprising predominantly circumsized men. Females had a shorter median time to clearance (8 weeks) compared to males (12 weeks). A low recurrence rate (13%) was found.
Although multiple clinical studies have validated the efficacy and safety of the currently indicated dosing regimen for imiquimod 5% cream for CA, the lengthy duration and sporadic frequency can affect patient compliance. Only one dose-response study exploring a daily treatment regimen with the imiquimod 5% cream has been published with results showing poor patient tolerance secondary to severe local inflammatory side effects. Of the 64 patients enrolled in this study, 13 were withdrawn prior to completion

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